HomeMy WebLinkAboutTab 38 - Christiam Kolm (Under Contract to Purchase by Magic City Properties XXIV, LLC)SPECIAL AREA PLAN APPLICATION
DISCLOSURE OF OWNERSHIP
List the owner(s) of the subject property and percentage of ownership. Note: The Miami City Code
requires disclosure of all parties having a financial interest, either direct or indirect, with respect to a
presentation, request or petition. Accordingly, disclosure of shareholders of corporations,
beneficiaries of trusts, and/or any other interested parties, together with their address(es) and
proportionate interest are required. Please supply additional lists, if necessary.
Owner's Name(es) MR. CHRISTIAN KOLM
Percentage of Ownership N/A. His mailing address is P.O. Box 1909618, Miami Beach, FL 33119.
Subject Property Address(es) 353 NE 61 st Street
2. List all street address(es) and legal description(s) of any property located within 500 feet of the
subject property owned by any and all parties listed in question #1 above. Please supply additional
lists, if necessary.
Street Address(es): Legal Description(s):
N/A
NEISEN O. KASDIN, his Attorney
Owner(s) or Attorney Name
Owner(s) or Attorney Signature
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
20 foreboins(aowigfy `enhis day of -5-NA•Pq
who is a(n) individual/partner/agent/ poration of a(n)
individual/partnership/corporation. I /She is personally known per who has produced
as identification and who did (di ace atoath.
(Stamp) Diana Perez Gata Signature
NOTARY PUBLIC
STATE OF FLORIDA
Comm# FF233833
Expires 6/8/2019
Rev. 07-2013
7
SPECIAL AREA PLAN APPLICATION
DISCLOSURE OF OWNERSHIP
List the owner(s) of the subject property and percentage of ownership. Note: The Miami City Code
requires disclosure of all parties having a financial interest, either direct or indirect, with respect to a
presentation, request or petition. Accordingly, disclosure of shareholders of corporations,
beneficiaries of trusts, and/or any other interested parties, together with their address(es) and
proportionate interest are required. Please supply additional lists, if necessary.
Owner's Name(es) MAGIC CITY PROPERTIES XXIV, LLC
Percentage of Ownership See attached corporate ownership chart.
Subject Property Address(es) UNDER CONTRACT TO PURCHASE: 353 NE 61st Street
2. List all street address(es) and legal description(s) of any property located within 500 feet of the
subject property owned by any and all parties listed in question #1 above. Please supply additional
lists, if necessary.
Street Address(es): Legal Description(s):
N/A
NEISEN O. KASDIN, its Attorney
Owner(s) or Attorney Name
Owner(s) or Akforney Signature
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
T foregoing w s cknowledged b fore me this day of
20 by r��f rY caI
who is n) individual a age tl r oration of a(n)
individual/partnership/corporation. WShe is personally kn r who has produced
as identification and who did (di no take ann oath. oath.
Diana Perez-Gata
NOTARY PUBLIC
STATE OF FLORIDA
Comm# FF233833
Expires 61812019
Signatur
Rev. 07-2013
7
AAA 2012 Trust
BENEFICIARIES:
Alexa, Ashley &
Amber Zangrillo
16244th Ave., Ste. 400
Seattle, WA 98101
42.49%
Robert
Zangrillo
11 E Dilido Dr.
Miami Beach, FL
33139
Neil Kadisha
9420 Wilshire Blvd.
Ste. 400
Beverly Hills, CA 90212
54.2% 3.31%
MCD Dragon, LLC,
a Delaware limited liability company
1209 Orange St.
Wilmington, DE 19801
The Akai Tsuki
Family Trust
BENEFICIARIES:
Guy Laliberte
Naima M. taliberte
Kami M. Laliberte
Moani Taini M. taliberte
Noa Taima B. Laliberte
Ina Kai B. taliberte
2200 Rue Stanley
Montreal, H3A 1 R6
Canada
MAGIC CITY PROPERTIES XXIV, LLC
OWNERSHIP CHART
Guy Laliberte
2200 Rue Stanley
Montreal, H3A 1 R6
Canada
Lune Rouge Illusion CT Inc.,
a Delaware corporation
251 Little Falls Dr.
Wilmington, DE 19808
Anthony Cho
3737 Collins Ave.
Apt. 1104
Miami Beach, FL 33137
100%
CHO MCD, LLC,
a Delaware limited liability company
1209 Orange St.
Wilmington, DE 19801
The Anthony Burns
Revocable Trust
BENEFICIARY:
Jessica Lynn Burns
2675 Hunter Ct.
Weston, FL 33331
George Helmstetter
550 Sabal Palm Rd.
Miami, FL 33137
MCD Miami, LLC,
a Delaware limited liability company
One SE 3rd Ave., Ste. 2110
Miami, FL 33131
100%
Neil Fairman
180 Palm Ave.
Miami, FL 33139
Magic City Properties XXIV, LLC,
a Delaware limited liability company
One SE 3rd Ave., Ste. 2110
Miami, FL 33131
Charles & Valerie
Rennert
156 Bal Cross Dr.
Bal Harbor, FL 33154
31.281%
48.725%
0.428%
0.428%
Howard & Amy Vogel
2127 Brickell Ave., Apt. 1002
Miami, FL 33129
Jose & Sandra
Rodriguez
498 SW 27th Road
Miami, FL 33129
Jeffrey & Rebecca
Mandler
12525 SW 69th Ave.
Miami, FL 33156
PEP Magic City Development, LLC,
a Florida limited liability company
One SE 3rd Ave., Ste. 2110
Miami, FL 33131
25%
Under Contract to
Purchase:
353 NE 61 st St.
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that Christian Kolm, an individual, has
made, constituted and appointed, and by these presents does make, constitute and appoint NEISEN
O. KASDIN, T. SPENCER CROWLEY III, STEVEN J. WERNICK, and BENJANHN O.
HEDRICK his true and lawful attorneys in its stead to execute all documents and instruments
required with respect to applications for a Special Area Plan and Comprehensive Plan Amendment
in connection with the Magic City Innovation District Special Area Plan, under the requirements of
the City of Miami Code of Ordinances and Miami 21 zoning code, submitted to the Office of
Hearing Boards, for the properties located at 353 NE 61 st Street in Miami, Florida, giving and
granting unto NEISEN O. KASDIN, T. SPENCER CROWLEY III, STEVEN J. WERNICK,
and BENJAIVIIN O. HEDRICK his said attorneys, full power and authority to do and perform all
and every act and thing whatsoever requisite and necessary to be done with respect to the
aforementioned Special Area Plan and Comprehensive Plan Amendment applications as fully, to all
intents and purposes, as he might or could do if personally present (including, without limitation,
preparing, executing and filing all documents and applications and attending all hearings and
meetings), with full power of substitution and revocation, hereby ratifying and confirming all that
said attorney or his substitute shall lawfully do or cause to be done by virtue hereof.
IN WITNESS WHEREOF, I have hereunto set my/our hand(s) and seal(s) this f day of
• ,2017.
Signed . • delivered in the presence of:
By:
Name:
itness Name N644te - l3 � e ,�- 044.1sk/
STATE OF FLORIDA
) SS:
COUNTY OF MIAMI-DADE )
neb .�z,1i�
))k
The foregoing instrument was acknowledged before me this - day of be(-P01 bPi 2-0/4-
by C hi/ -h'm V c'-E1N-, who is personally known to me or who has produced a
�5�rmit �Gn� �v. c - as identification.
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WRITTEN CONSENT
OF
MAGIC CITY PROPERTIES XXIV, LLC
The undersigned, being the Sole Member and Manager of Magic City Properties XXIV,
LLC, a Delaware limited liability company (the "Company"), does hereby consent and agree to the
adoption of, and does hereby adopt, the following resolutions of the Company in lieu of holding a
meeting in accordance with the governing documents of the Company, and directs that these
resolutions be filed in the records of the Company:
WHEREAS, in regard to the properties the Company currently has under contract to
purchase at 353 NE 61st Street in Miami, Florida, the undersigned Sole Member and Manager deems
it advisable and in the best interests of the Company for the Company to join in and submit an
application to the City of Miami seeking approval of the Magic City Innovation District Special Area
Plan and related Comprehensive Plan Amendments, generally prepared in accordance with the
application forms published by the City of Miami (collectively, the "Application"); and
WHEREAS, in connection with the preparation, filing and formal review and processing of
the Application, including without limitation the execution and delivery of any and all documents
and forms required for the Application, the undersigned Sole Member and Manager deems it
advisable and in the best interests of the Company for the Company to grant Neisen O. Kasdin, T.
Spencer Crowley III, Steven J. Wernick and Benjamin O. Hedrick a power of attorney pursuant to
that certain Power of Attorney attached hereto as Exhibit A (the "Power of Attorney").
NOW THEREFORE, BE IT RESOLVED, that the Application and the Power of Attorney
are hereby authorized, approved, adopted, confirmed and ratified in all respects;
FURTHER RESOLVED, that any member, manager, officer or other authorized
representative of the Company (each being referred to herein as an "Authorized Person"), including
without limitation Neil Fairman, Anthony Burns and George Helmstetter, acting alone, be and hereby
is, authorized and empowered to execute and deliver on behalf of the Company any and all
agreements, instruments, certificates or documents necessary to consummate or effectuate the
Application and the Power of Attorney, in the name and on behalf of the Company;
FURTHER RESOLVED, that each Authorized Person is hereby authorized, empowered
and directed, in the name and on behalf of the Company to make or cause to be made, and to execute
and deliver, all such agreements, documents, instruments and certifications, and to do or cause to be
done all such acts and things, and to take all such steps, as he or she may at any time or times deem
necessary or desirable in order to carry out the intent and purposes of the foregoing resolutions; and
FURTHER RESOLVED, that the authorities and approvals hereby conferred shall be
deemed retroactive, and any and all acts authorized and approved herein that were performed prior to
the passage of this resolution be, and they hereby are, approved, ratified and confirmed in all
respects.
[Signature on following page)
IN WITNESS WHEREOF, the undersigned has executed this Written Consent as of the C
day of Dece4k e . , 2017.
COMPANY:
MAGIC CITY PROPERTIES XXIV LLC
By: MCD Miami, LLC, its Sole Member and
Manager
By: ~eg—
Name: George Helmstetter
Title: Authorized Representative
EXHIBIT A
Power of Attorney
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that MAGIC CITY PROPERTIES XXIV,
LLC, a Delaware limited liability company, has made, constituted and appointed, and by these presents
does make, constitute and appoint NEISEN O. KASDIN, T. SPENCER CROWLEY III, STEVEN J.
WERNICK, and BENJA1VIIN O. HEDRICK its true and lawful attorneys in its stead to execute all
documents and instruments required with respect to applications for a Special Area Plan and
Comprehensive Plan Amendment, in connection with the Magic City Innovation District Special Area
Plan, under the requirements of the City of Miami Code of Ordinances and Miami 21 zoning code,
submitted to the Office of Hearing Boards, for the properties it has under contract to purchase located at
353 NE 61st Street in Miami, Florida, giving and granting unto NEISEN O. KASDIN, T. SPENCER
CROWLEY III, STEVEN J. WERNICK, and BENJAMIN O. HEDRICK its said attorneys, full
power and authority to do and perform all and every act and thing whatsoever requisite and necessary to
be done with respect to the aforementioned Special Area Plan and Comprehensive Plan Amendment
applications as fully, to all intents and purposes, as it might or could do if personally present (including,
without limitation, preparing, executing and filing all documents and applications and attending all
hearings and meetings), with full power of substitution and revocation, hereby ratifying and confirming
all that said attorney or his substitute shall lawfully do or cause to be done by virtue hereof.
IN WITNESS WHEREOF, I have hereunto set my/our hand(s) and seal(s) this 20 day of
t cer&oer , 2017.
Signed and delivered in the presence of:
Witness Signaturh/
Y ia Eior)
Witness Name
Witness Signature
3se-rinc.
Ca— s-h '
Witness Name
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
) SS:
Magic City Properties XXIV, LLC
By:
Name: George Helmstetter
Title: Authorized Representative
•
The for oing instrument was acknowledged before me this 20 day of'°«'►'Yt�°( All/ by
aTCc (-Fetter who is personally known to me or who has produced a
as identification.
(d)( C
NOTARY PUBLIC
Print Name:
My commission expires:
?°S� '�`B��p MARIA GONZALEZ
* MY COMMISSION # FF 909142
EXPIRES: October 22, 2019
��9f4.
0
F R.00 Bonded Thru Budget Notary Services
6l)2D►cr1
Et pared by and return to:
Philip Gpldin
Royal Title & Escrow Company, Inc.
555 N.E. 15th Street Suite 100
Miami, FL 33132
OFF. AEC OK.
19885PG0550
r 1R48769 1 2001 SEP 06 10:36
D0t'STPDEE 438.00 SURTX 328.50
i Number: 011301CM HARVEY RUVIl4t CLERK DADE COUNTY, FL
Will Call No.: 136
l5pacc AboveThit Lino Foe Recording Dalai
Warranty Deed
This Warranty Deed made this 31st day of August, 2001 between WILFREDO VASQUEZ and ROBIN D.
VASQUEZ, husband and wife whose post office address is 910 SW 116 TERRACE, Hollywood, FL 33025, grantor, and
CHRISTIAN KOLM, a single man whose post office address is 100 WEST AVENUE, PII-6, Miami Beach, FL 33139,
grantee:
(Whenever used herein the tome and "garnet" include all the parties to this nutriment and the heir, Legal repeesentalives, and assigns of individuals,
and the enamors and wipe oroorpontimu. trusts and trustees)
W itnesseth, that said grantor, for and in consideration of the sum of TEN AND NO/100 DOLLARS (S10.00) and other
good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged.
has granted, bargained, and sold to the said grantee, and grantee's heirs and assigns forever, the following described land,
situate. lying and being in Miami -Dade County. Florida to -wit:
Lot 5, less the South 2.5 feet, in Block 18, of SECOND CORRECTIVE PLAT OF PIERCES SUBDIVISION
OF LEMON CITY, according to the Plat thereof, as recorded in Plat Book 2, at Page 21, of the Public
Records of Miami -Dade County, Florida
Parcel Identification Number, 01.3218-015-0740
Together with all the tenements, hcrcditamcnts and appurtenances thereto belonging or in anywise appertaining.
To Have and to Hold. the same in fix simple forever.
And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee sitnple; that the
grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to
said land and will defend the same against the lawful claims of all persons whomsoever, a . that said land is free of all
encumbrances, except taxes accruing subsequent to December 31, 2000.
In Witness Whereof, grantor has hereunto set grantor's hand and scal the day an. car ' rst 1 .vc written.
S. d, scaled and delivered in our presence:
W'
it ess Name. !I
Wj►f Nant•: .�
.o.asra+t•�
anus Name; L�
(ta
DoubteTlme.
OFF REC8X,
19885%G0551
State of Florida
County of Miami -Dade
The foregoing instrument was acknowledged before me this 31st .., of August. 2001 by WILFREDO VASQUEZ and
ROBIN B. VASQUEZ, who (j arc personally known or [X1 have . a driver's license as identification.
Notary Scall Notary ' ,lic
Printed Name: l L I 1.0
My Commission Expires:
Vl :.1 Jf lL
P111LI ' ' •d COLDIN
NOTARYPUI . OF FLORIDA
COMM155P: `d i:O. CCB52504
MYCOuoKrIrN}Xr�ULY62M4
RECOW.E.Owlirt,p
RECOHo verbriEo
HARVEY RUVIN
CLcRx CIRCUIT count
Doubt eTI me.
IVarranO Dud - Page 2
State of Florida
Department of State
I certify from the records of this office that MAGIC CITY PROPERTIES
XXIV, LLC is a Delaware limited liability company authorized to transact
business in the State of Florida, qualified on November 17, 2017.
The document number of this limited liability company is M17000009808.
I further certify that said limited liability company has paid all fees due this
office through December 31, 2018, that its most recent annual report was filed
on March 7, 2018, and that its status is active.
I further certify that said limited liability company has not filed a Certificate of
Withdrawal.
Given under my hand and the
Great Seal of the State of Florida
at Tallahassee, the Capital, this
the Fifth day of June, 2018
i&-s%
Secretary of State
Tracking Number: CU5920910505
To authenticate this certificate,visit the following site,enter this number, and then
follow the instructions displayed.
https://services.sunbiz.org/Filings/CertificateofStatus/CertificateAuthentication
Delaware
The First State
I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY GEXTIFY THE ATTACHED IS A TRUE AND CORRECT
COPY OF THE CERTIFICATE OF FORMATION OF "MAGIC CITY PROPERTIES
XXIV, LLC", FILED IN THIS OFFICE ON THE THIRTEENTH DAY OF
NOVE1P ER, A.D. 2017, AT 11:58 O'CLOCK A.M.
6613610 8100
SR# 20177438910
You may verify this certificate online at corp.delaware.gov/authver.shtml
Page 1
Authentication: 203789331
Date: 12-19-17
State of Delaware
Secretary of State
Division of Corporatlons
Delivered 11:58 AM 11/13/2017
CERTIFICATE OF FORMATION FILED 11:58 AM 11/13/2017
SR 20177049423 - File Number 6613610
OF
MAGIC CITY PROPERTIES XXIV, LLC
1. The name of the limited liability company (hereinafter called the "LLC") is Magic City
Properties XXIV, LLC.
2. The registered office of the LLC is to be located at 1013 Centre Road, Suite 403S,
Wilmington, DE 19805. The name of the registered agent located at such address is
Registered Agents Legal Services, LLC,
IN WITNESS WHEREOF, the undersigned Member has executed this Certificate of
Formation of Magic City Properties XXIV, LLC this 1014 day of November, 2017.
George Helmstetter,
Authorized Representative of Member
CITY OFMIAMI
DISCLOSURE OF CONSIDERATION PROVIDED OR COMMITTED FOR AGREEMENT TO
SUPPORT OR WITHHOLD OBJECTION
The City of Miami requires any person or entity requesting approval relief or other action from the City Commission or any of its
boards, authorities, agencies, councils or committees, to disclose at the commencement (or continuance) of the hearing(s) on the
issue, any consideration provided or committed, directly or on its behalf, to any entity or person for an agreement to support or
withhold objection to the requested approval, relief or action. "Consideration" includes any gift, payment, contribution, donation, fee,
commission, promise or grant of any money, property, service, credit or financial assistance of any kind or value, whether direct or
implied, or any promise or agreement to provide any of the foregoing in the future.
Individuals retained or employed by a principal as a lobbyist as defined in Sec. 2-653, and appearing before the City Commission or
any of its boards, authorities, agencies, councils or committees solely in the capacity of a lobbyist and not as the applicant, or owners'
legal representative are not required to fill out this form.
NAME: Neisen O. Kasdin
(First Name)
(Middle) (Last Name)
HOME ADDRESS: c/o Akerman LLP, 98 SE 7th Street, Suite 1100
(Address Line 1)
(Address Line 2)
CITY: Miami STATE: Florida ZIP: 33131
HOME PHONE: (3 0 5) 9 8 2- 56 2 9 CELL PHONE: FAX:
EMAIL: neisen.kasdin@akerman.com
BUSSINESS or APPLICANT or ENTITY NAME
Christian Kolm
BUSINESSADDRESS: P.O. Box 1909618
(Address Line 1)
Miami Beach, FL 33119
(Address Line 2)
1. Please describe the issue for which you are seeking approval, relief or other action from the City Commission, board,
authority, agency, council, or committee.
Approval of the Magic City Innovation District Special Area Plan (SAP).
2. Has any consideration been provided or committed, directly or on your behalf, to any entity or person for an agreement to
support or withhold objection to the requested approval, relief or action?
❑ YES X❑ NO
If your answer to Question 2 is No, do not answer questions 3, 4 & 5 proceed to read and execute the Acknowledgment. If
your answer to Question 2 is Yes, please answer questions 3, 4 & 5 and read and execute the Acknowledgement.
Doc. No.:86543
3. Please provide the name, address and phone number of the person(s) or entities to whom consideration has been provided
or committed.
Name Address Phone4
a. n/a
b.
c.
* Additional names can be placed on a separate page attached to this fonn.
4. Please describe the nature of the consideration.
n/a
5. Describe what is being requested in exchange for the consideration.
n/ a
ACKNOWLEDGEMENT OF COMPLIANCE
I hereby acknowledge that it is unlawful to employ any device, scheme or artifice to circumvent the disclosure requirements of
Ordinance 12918 and such circumvention shall be deemed a violation of the Ordinance; and that in addition to the criminal
or civil penalties that may be imposed under the City Code, upon determination by the City Commission that the foregoing
disclosure requirement was not fully and timely satisfied the following may occur:
1. the application or order, as applicable, shall be deemed void without further force or
effect; and
2. no application from any person or entity for the same i sue shall be reviewed or
considered by the applicable board(s) until expiration o eriod of one year after the
nullification of the application or order.
PERSON SUBMITTING DISCLOSURE:
i n Lure
Neisen O. Kasdin
Print Name
. The foregoing
Sworn to and subscribed before me this day of , 200
fi ,
instrument was acknowledged before me by I
w o has produced
not take an oath.
as identification :�; ' ,. e on y k own to me and who did/did
C dCl h`
Diana Perez -Gala
�'11NOTARY yP.UBLIC
e ''' tier FLORIDA
+Mw�'\a/ “ min# FF233833
M '' ':-4'.' IE3M6/8/2019 1 p tisOnA
EXPIRES: 11
C
Print Name
Enclosure(s)
Doc. No.:86543 Page 2
CITY OFMIAMI
DISCLOSURE OF CONSIDERATION PROVIDED OR COMMITTED FOR AGREEMENT TO
SUPPORT OR WITHHOLD OBJECTION
The City of Miami requires any person or entity requesting approval relief or other action from the City Commission or any of its
boards, authorities, agencies, councils or committees, to disclose at the commencement (or continuance) of the hearing(s) on the
issue, any consideration provided or committed, directly or on its behalf, to any entity or person for an agreement to support or
withhold objection to the requested approval, relief or action. "Consideration" includes any gift, payment, contribution, donation, fee,
commission, promise or grant of any money, property, service, credit or financial assistance of any kind or value, whether direct or
implied, or any promise or agreement to provide any of the foregoing in the future.
Individuals retained or employed by a principal as a lobbyist as defined in Sec. 2-653, and appearing before the City Commission or
any of its boards, authorities, agencies, councils or committees solely in the capacity of a lobbyist and not as the applicant, or owners'
legal representative are not required to fill out this form.
NAME: Neisen O. Kasdin
(First Name)
(Middle) (Last Name)
HOME ADDRESS: c/o Akerman LLP, 98 SE 7th Street, Suite 1100
(Address Line 1)
(Address Line 2)
CITY: Miami STATE: Florida ZIP: 33131
HOMEPHONE: (3 0 5) 9 8 2- 5 6 2 9 CELL PHONE: FAX:
EMAIL: neisen.kasdin@akerman.com
BOSSINESS or APPLICANT or ENTITY NAME
Magic City Properties XXIV, LLC
BUSINESS ADDRESS: One SE 3rd Avenue, Suite 2110
(Address Line 1)
Miami, FL 33131
(Address Line 2)
1. Please describe the issue for which you are seeking approval, relief or other action from the City Commission, board,
authority, agency, council, or committee.
Approval of the Magic City Innovation District Special Area Plan (SAP).
2. Has any consideration been provided or committed, directly or on your behalf, to any entity or person for an agreement to
support or withhold objection to the requested approval, relief or action?
YES 0 NO
If your answer to Question 2 is No, do not answer questions 3, 4 & 5 proceed to read and execute the Acknowledgment. If
your answer to Question 2 is Yes, please answer questions 3, 4 & 5 and read and execute the Acknowledgement.
Doc. No.:86543
3. Please provide the name, address and phone number of the person(s) or entities to whom consideration has been provided
or committed.
Name Address Phone#
a. n/a
b.
c.
* Additional names can be placed on a separate page attached to this form.
4. Please describe the nature of the consideration.
n/ a
5. Describe what is being requested in exchange for the consideration.
n/ a
ACKNOWLEDGEMENT OF COMPLIANCE
I hereby acknowledge that it is unlawful to employ any device, scheme or artifice to circumvent the disclosure requirements of
Ordinance 12918 and such circumvention shall be deemed a violation of the Ordinance; and that in addition to the criminal
or civil penalties that may be imposed under the City Code, upon determination by the City Commission that the foregoing
disclosure requirement was not fully and timely satisfied the following may occur:
1. the application or order, as applicable, shall be deemed void without further force or
effect; and
2. no application from any person or entity for the same issue shall be reviewed or
considered by the applicable board(s) until expiration o period of one year after the
nullification of the application or order.
PERSON SUBMITTING DISCLOSURE:
na ure
Neisen O. Kasdin
Print Name
(
, 24
Sworn t0 and subscribed before me this day of
The foregoing
instrument was acknowledged before me by
ip , who has produced
who did/did not take an oath.
as identification n , el ona_ '
know
to me n
S"I A I' '% ; ' ; OIT Perez-Gata
CIT .% .0NOTARY PUBLIC
MY ` Comm# FF2333833UA
EXP .:.n., , .
Notary
6ecv
''. ' Expires 6/8/2019
Print Name
Enclosure(s)
Doc. No.:86543 Page 2
Paid By Christian Kolm
Miami -Dade County, Florida
Paid 03/06/2018
plicate public user 06/04/2018
Receipt# ECHECK-18-157431 $12,574.35
2017 Real Estate Property Taxes
Notice of Ad Valorem Tax and Non -Ad Valorem Assessments
SEE REVERSE SIDE FOR IMPORTANT INFORMATION
FOLIO NUMBER
MUNICIPALITY
MILL CODE
01-3218-015-0740
MIAMI
0100
CHRISTIAN KOLM
PO BOX 190618
MIAMI BEACH, FL 33119
Property Address
353 NE 61 ST
Exemptions:
AD VALOREM TAXES
Miami -Dade School Board
School Board Operating
School Board Debt Service
State and Other
Florida Inland Navigation Dist
South Florida Water Mgmt Dist
Okeechobee Basin
Everglades Construction Proj
Childrens Trust Authority
Miami -Dade County
County Wide Operating
County Wide Debt Service
Library District
Municipal Governing Board
Miami Operating
Miami Debt Service
642,295
642,295
462,442
462,442
462,442
462,442
462,442
462,442
462,442
462,442
6.77400
0.22000
0.03200
0.12750
0.13840
0.04410
0.46730
4.66690
0.40000
0.28400
462,442 7.43650
462,442 0.59350
642,295
642,295
462,442
462,442
462,442
462,442
462,442
462,442
462,442
462,442
462,442
462,442
4,350.91
141.30
14.80
58.96
64.00
20.39
216.10
2,158.17
184.98
131.33
3,438.95
274.46
NON -AD VALOREM ASSESSMENTS
F0001 CITY OF MIAMI WASTE
@ 380.0000
4.000
1,520.00
Save Time. Pay Online. www.miamidade.gov
t RETAIN FOR YOUR RECORDS t
(Combined taxes and assessments
$12,574.35
i
2017 Real Estate Property i DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT 4-
Taxes
FOLIO NUMBER
01-3218-015-0740
PROPERTY ADDRESS
353 NE 61 ST
LEGAL DESCRIPTION
PIERCES LEMON CITY PB B-43 & 2-21
1EG 1001FTE OF NW COR OF SW1/4
N95.07FT E70.89FT S199.02
CHRISTIAN KOLM
PO BOX 190618
MIAMI BEACH, FL 33119
111111 11111 II II II III II
0 1 3 2 1 8 0 1 5 0 7 4 0+
Make checks payable o:
Miami -Dade Tax Collector
(in U.S. funds drawn on U.S. banks)
Amount due May be Subject to Change Without Notice
Mail payments to:
200 NW 2nd Avenue, Miami, FL 33128
Du.licate .ublic user06/04/2018
PAY ONLY ONE AMOUNT
If Paid By Please Pay
Mar 31, 2018 $0.00
..110111.
1000000000000000000132180150740201700000000000000000000003